The Strategic Health Authority for London
Planning 2007/8:PCT Operating Plans
SHA Board Meeting
28 March 2007
Enclosure N
Appendix 1
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Contents
Topic Slide
Executive Summary - 2
Description of risk ratings - 3
PCT risk ratings (proposed) - 4
Overview of risk ratings - 5
Next Steps - 6
Appendices
Details of governance ratings - 8-11
Details of quality and service - 12-14
performance ratings, including
health improvement ambition
Glossary of terms - 15
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Executive summary
The Board is asked to
Sign off Operating Plans for 23 PCTs, subject to reconciliation with satisfactory and robust FIMS plans and to sign-off of the overall LDP by the DH
Agree risk ratings (also subject to agreement of the above)
Where plans are not agreed ensure that PCTs deliver robust and credible plans as a matter of urgency.
Agree that delegated authority is provided to the SHA Chair and CE to sign off the remainder of the plans
• The PCTs have submitted Operating Plans in response to the DH Operating Framework and the SHAs Planning Guidance.
• The PCTs are planning to achieve all the key targets in 2007/8 and most of the other LDP targets.
• In aggregate PCT plans are broadly breakeven (after debt repayment and topslice).
• However, 8 individual plans require further work / discussion are not yet in a position to be signed off.
The provisional risk ratings are set out in slides 4 & 5
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Processes fail to sufficiently ensure good governance in key areas
Persistent or deliberate failure to address other areas of governance
Operating plans will be used to assess PCT risk rating in 3 areas
Quality and outcomes GovernanceFinance
5
4
3
Meeting all key national targets and 85% of other targets within green tolerance
Processes in place to ensure good governance or achievable action plans to address areas of concern
Consistent good performance
Reasonable surplus
Achieving balance
2 Risk of failing to achieve 1 or more key national targets
Risk of achieving below 85% of other targets within green tolerance
Concern in 1 or more areas where insufficient remedial action is being taken to ensure good governance when necessary
Small deficit Risk of not achieving balance
High risk of failing to meet several of the national priorities or below 75% of other targets within green tolerance
Significant deficit High risk of not achieving
balance
1
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Recommended risk ratingsPCT Finance
Quality & Service Targets Governance
Status of plan
Monitoring regime
Surplus/ (deficit) £m, 2007/8
Barking and Dagenham PCT 4 Agreed Quarterly 6.0
Barnet PCT 2 Agreed Monthly 0
Bexley Care Trust 1 Not yet agreed Monthly Not yet agreed
Brent Teaching PCT 2 Agreed Monthly 0
Bromley PCT 3 Agreed Quarterly 0
Camden PCT 3 Agreed Quarterly 0
City and Hackney Teaching PCT
4 Agreed Quarterly 1.0
Croydon PCT 3 Agreed Quarterly 0
Ealing PCT 3 Agreed Quarterly 0
Enfield PCT 1 Not yet agreed Monthly Not yet agreed
Greenwich Teaching PCT 2 Agreed Monthly 0.1
Hammersmith and Fulham PCT
4 Agreed Quarterly 0
Haringey Teaching PCT 3 Agreed Quarterly 1.9
Harrow PCT 2 Agreed Monthly 0
Havering PCT 1 Not yet agreed Monthly Not yet agreed
Hillingdon PCT 1 Not yet agreed Monthly Not yet agreed
Hounslow PCT 1 Not yet agreed Monthly Not yet agreed
Islington PCT 2 Agreed Monthly 0
Kensington and Chelsea PCT 3 TBC Agreed Quarterly 0
Kingston PCT 1 Not yet agreed Monthly Not yet agreed
Lambeth PCT 3 Agreed Quarterly 0
Lewisham PCT 2 Agreed Monthly 0
Newham PCT 2 Agreed Monthly 0
Redbridge PCT 4 Agreed Quarterly 2.0
Richmond and Twickenham PCT
3 Agreed Quarterly 1.2
Southwark PCT 2 Agreed Monthly 0
Sutton and Merton PCT 1 Not yet agreed Monthly Not yet agreed
Tower Hamlets PCT 4 Agreed Quarterly 0
Waltham Forest PCT 2 Not yet agreed Monthly Not yet agreed
Wandsworth PCT 4 Agreed Quarterly 2.1
Westminster PCT 4 Agreed Quarterly 3.0
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Overview of initial PCT ratings and implications for the monitoring regime
Implications for monitoring regimePCTs Finance Quality Governance
Ratings
Lo
w r
isk
Barking and Dagenham* City and Hackney Hammersmith & Fulham Redbridge Tower Hamlets Wandsworth Westminster
4
Med
ium
ris
k
Bromley Camden Croydon Ealing Haringey Kensington &
Chelsea Lambeth Richmond
2/3
Hig
he
r r
isk Bexley
Enfield Havering Hillingdon Hounslow Kingston Sutton and
Merton
1/2
Ideally the majority of PCTs would be in the ‘low risk’ category. It is anticipated that this will be the trend, but the timing is of course dependent on future performance.
NHS London will need to focus its support on the most challenged PCTs
At the start of ’07/8 around half the PCTs will be required to submit monthly monitoring reports (i.e. all ‘higher risk’ PCTs and the ‘medium risk’ PCTs rated a 2 on finance).
As soon as confidence in ’07/8 performance warrants it all the ‘medium risk’ PCTs will be switched to quarterly reporting.
The ‘low risk’ PCTs will move to six-monthly reporting during ’07/8, on a case by case basis.
Brent Lewisham Waltham Forest
Barnet Greenwich Harrow Islington Newham Southwark
* At SHA discretion Barking & Dagenham PCT moved to ‘low risk’ as its amber governance issue is on an LAA ‘stretch’ target.
N.B. These PCTs have ratings of 4 / green / green
N.B. These PCTs have ratings of 2/3 or amber or amber
N.B. These PCTs have ratings of 1/2 or red or red
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The SHA is taking a number of steps to address emerging common themes
What this entails How it will help
Fitness for Purpose Development Plans
PCTs are producing Development Plans to respond to the issues identified in the diagnostic assessment
The Development Plans will address issues of capacity and capability to enable the PCTs to deliver their Operating Plans
Step
Programme work on 18 weeks
The 18 week waiting time target for referral to treatment will require some coordination at SHA level
The SHA will review plans, provide advice and coordinate the delivery of improved service pathways to achieve the waiting time targets
Programme work on health improvement
The SHA (inc. Regional Public Health and London Health Observatory) will review PCT action plans and support PCTs
Targeted support, e.g. on smoking or GUM access, will be focussed on the key interventions at the most challenged organisations
Benchmarking
The SHA will provide information and some analytical support to PCTs and Trusts to benchmark their performance
High quality benchmarking information will enable organisations to focus efforts on the areas likely to result in the greatest improvement
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Appendices
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Governance (top three) Clinical Governance - effective processes for
monitoring (in qualitative and quantitative terms) the experience of the full spectrum of patients and other users of services commissioned by the PCT
Clinical Governance - effectively monitoring and managing (a) the clinical and public health outcomes of its own provider arm, with clearly tracked, owned and understood metrics and a system of intervention; and (b) that its provider clinicians are appropriately qualified and trained;
Delivery and Financial Governance - information systems are suitable for fulfilling its financial and clinical needs and the information is used for performance management.
Governance ratings
Governance13%
55%
32%
n
n
n
Key themes
Red-rated PCTs;
• Bexley• Brent • Enfield• Havering• Hillingdon • Hounslow • Kingston • Lewisham • Sutton & Merton • Waltham Forest
GreenAmberRed
Bexley Care Trust
Havering PCT
Barking & Dagenham PCT
Croydon PCT
Sutton & Merton PCT
Enfield PCT
Redbridge PCT
Greenwich Teaching PCT
Lewisham PCT
Southwark PCT
Lambeth PCT
Kingston PCT
Richmond & Twickenham PCT
Wandsworth PCT
Haringey TPCT
Barnet PCT
Hillingdon PCT
Harrow PCT
Ealing PCT
Hounslow PCT
Camden PCTIslington
PCT
City & Hackney
TPCT
Tower Hamlets PCT
Waltham Forest PCT
Newham PCTWestminster
PCTHammersmith &
Fulham PCT
Kensington and Chelsea PCT
Brent PCT
Bromley PCT
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Board processes Member interests Member qualifications Non-executive skills and training Compliance with legal duties† Compliance with NHS
good practice †
Strategy and planning Contracts and SLAs agreed
with providers Board satisfaction with operating
plan assumptions
Delivery Plans/processes to deliver
operating plan † Management capable of delivering
operating plan † Appropriate management and staff
recruited Management and staff training and
accountability Information systems suitability
Financial governance Effective accounting and reporting
arrangements † Risk management and internal audit
† Probity and propriety Information systems suitability
Clinical governance Monitoring and improvement of
healthcare † National core standards & targets
Wal
tham
Fo
rest
X
Cit
y &
Hac
kney
X
L
amb
eth
So
uth
war
k
Kin
gst
on
X
X
X
X
X
Source: Operating plan self certifications; Team analysis
Bar
kin
g &
D
agen
ham
En
fiel
d
X
X
X
X
Hav
erin
g
New
ham
X
X
Red
bri
dg
e
To
wer
Ham
lets
X
Bex
ley
X
Cro
ydo
n
Gre
enw
ich
Ric
hm
on
d
& T
wic
ken
ham
Su
tto
n &
Mer
ton
X
X
Wan
dsw
ort
h
Lew
ish
am
X
X
X
Bar
net
X
X
Har
ing
ey
Bro
mle
y
B
ren
t
X
Cam
den
Eal
ing
Ham
mer
smit
h
& F
ulh
am
Har
row
Hil
lin
gd
on
X
X
Ho
un
slo
w
X
X
X
X
X
Isli
ng
ton
K
ensi
ng
ton
&
Ch
else
a
Wes
tmin
ster
PCT governance risk ratings (1/2)
X
X
Yes Not
certified
No
but with
plan
Denotes highly weighted questions
† X X
X
X
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Emergency planning Emergency governance † Emergency resources † Major Incident Plan † Emergency exercises, training
and testing †
Overall compliance Compliance with statutory
duties † Consideration of risks to
statutory duties † Review evidence of risk to
statutory duties †
Relationship management Engagement of local authority
and others Compliance with NHS London
and DH requirements Response to all regulators and
audits Relationship with providers Public patient involvement
Source: Operating plan self certifications; Team analysis
Overall risk rating(commissioner perspective)*
Clinical governance (continued) Monitoring experience of services
provided Monitoring experience of services
commissioned Provider arm performance and
staff Involvement of GP practices LAA target achievement
Ho
un
slo
w
Ken
sin
gto
n
& C
hel
sea
Ham
mer
smit
h
& F
ulh
am
Cam
den
Wes
tmin
ster
New
ham
X
X
To
wer
Ham
lets
X
X
X
Cit
y &
Hac
kney
X
So
uth
war
k
Cro
ydo
n
X
Kin
gst
on
X
X
X
Wan
dsw
ort
h
En
fiel
d
Bar
kin
g &
D
agen
ham
XB
ren
t
X
X
Har
row
Hil
lin
gd
on
X
X
X
Isli
ng
ton
X
X
X
Bar
net
Hav
erin
g
X
X
X
Red
bri
dg
e
X
X
Wal
tham
Fo
rest
X
X
Bex
ley
X
X
Bro
mle
y
Gre
enw
ich
Ric
hm
on
d
& T
wic
ken
ham
X
Su
tto
n &
Mer
ton
X
X
Eal
ing
Lew
ish
am
X
X
Har
ing
ey
X
X
Lam
bet
h
PCT governance risk ratings (2/2)
X
X
X
X
X
X
Yes Not
certified
No but
with
plan
Denotes highly weighted questions
† X X
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Quality & Service Targets
A number of targets are subject to revision as part of the national LDP phase 3 process, and therefore the assessments are subject to amendment when the final LDP is signed-off by the DH in April / May.
All PCTs are intending to deliver the 18 week referrals to treatment milestones
All PCTs are intending to achieve the key targets, with he exception of 5 PCTs on the all age all cause mortality target
Quality and Service Targets risk ratings
nQuality & Service Targets
3%3%
94%
0%
n
n
Key themes
Red-rated PCTs;
None
Amber • Enfield
To be confirmed (following discussions with the DH on the sign-off of
one key target)• Kensington and Chelsea
GreenAmberRed
Bexley Care Trust
Havering PCT
Barking & Dagenham PCT
Croydon PCT
Sutton & Merton PCT
Enfield PCT
Redbridge PCT
Greenwich Teaching PCT
Lewisham PCT
Southwark PCT
Lambeth PCT
Kingston PCT
Richmond & Twickenham PCT
Wandsworth PCT
Haringey TPCT
Barnet PCT
Hillingdon PCT
Harrow PCT
Ealing PCT
Hounslow PCT
Camden PCTIslington
PCT
City & Hackney
TPCT
Tower Hamlets PCT
Waltham Forest PCT
Newham PCTWestminster
PCTHammersmith &
Fulham PCTKensington and
Chelsea PCT
Brent PCT
Bromley PCT
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Quality and service target ratingsPCT Risk rating
% other national targets PCT plans to achieveNational key target breaches
Barking and Dagenham PCT – 100
Barnet PCT – 95
Brent Teaching PCT – 90
Bromley PCT - 95
Camden PCT - 90
City and Hackney Teaching PCT
- 95
Croydon PCT - 90
Ealing PCT - 86
Enfield PCT – 62
Greenwich Teaching PCT - 81
Hammersmith and Fulham PCT – 95
Haringey Teaching PCT
– 86
Harrow PCT – 95
Havering PCT – 90
Hillingdon PCT - 90
Hounslow PCT – 81
Islington PCT – 81
Kensington and Chelsea PCT
All age all cause mortality is subject to DH agreement 100
Kingston PCT 76
Lewisham PCT - 81
Redbridge PCT - 86
Richmond and Twickenham PCT – 76
Southwark PCT
- 86
Sutton and Merton PCT
– 86
Tower Hamlets PCT - 90
Waltham Forest PCT – 86
Wandsworth PCT – 90
Westminster PCT – 95
Lambeth PCT – 81
Newham PCT – 86
Bexley Care Trust
- 81
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PCTs in a sustainable finance position and / or with significant growth have defined local priorities and action plans. NHS London will be monitoring delivery against these plans. There are three PCTs in this category:
Barking and Dagenham City and Hackney Tower Hamlets
Health Improvement Ambition
n
n
• PCTs in financial balance were also asked to review progress on TB and HIV in the London guidance of December 2006. There are six additional PCTs in this category which was made on the basis of M11 (forecast outturn):
• Hammersmith and Fulham• Kensington and Chelsea • Lambeth• Redbridge• Wandsworth• Westminster• Barking and Dagenham• City and Hackney• Tower Hamlets
LOCAL HEALTH PRIORITIES
LONDON PRIORITIES
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Glossary of terms
Risk rating NHS London assesses the risks in each PCT’s Operating Plan and assigns a risk rating in three areas: financial performance, quality and outcomes and governance. NHS London will use the risk ratings to guide the intensity of its monitoring and signal to the PCT its degree of concern with the specific issues identified and evaluated in the Operating Plan review.
Finance rating The risk that the PCT will end the year in deficit (refer to slide 3 for meaning of the finance ratings and to the PCT Commissioning Regime for the methodology for calculating the ratings)
Governance rating
The risk posed by the PCT’s governance systems and processes (a summary of the results of the governance self certification questionnaires is set out in slides 8- 10, the methodology for calculating the ratings is set out in the PCT Commissioning Regime)
Quality rating The risk that the PCT and its commissioned services will not deliver national, London-wide and local quality and outcomes targets (the targets and the methodology for calculating the ratings are set out in the PCT Commissioning Regime)
Operating plan Sets out how the PCT plans to achieve the health outcome and financial goals for the year. In future years will be based on its Commissioning Strategy Plan. It includes targets, financial and activity schedules and action plans. Developed annually.
Monitoring regime
As part of the PCT Commissioning Regime, intervention is also underpinned by the Regime’s overall principles: (1) self-governance, (2) risk-based, proportionate approach, (3) trust, (4) transparency, (5) minimal information requirements and (6) developmental
CIPs Cost Improvement Programmes, initiatives developed each year by service providers to improve efficiency
DP Development Plan - describes the organisational capabilities needed to deliver the Commissioning Strategy Plan, the current capability gaps and how they will be filled, for 2007/8 this will be the Fitness for Purpose Development Plan
Contingency Resource retained to mitigate in-year financial pressures, DH guidance is that this should be 0.5% of turnover as an absolute minimum
FIMS Financial Information Management Systems, a system of financial plans and monthly reporting against them
London Planning Guidance
Guidance issued to PCTs and Trusts by NHS London each year to inform the planning process, including confirmation of the targets to be delivered in the following year and of the financial planning assumptions to be used by organisations in producing their annual and operating plans
Demand management
Action being take by PCTs to ensure that services respond most appropriately to need including being located in the most appropriate places to provide quality, personalised care. Strategic context is set by the Our Health, Our Care, Our Say White Paper
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